Clinical communication on the medical wards can be interruptive and inefficient. However, effective communication is critical to the safety and quality of patient care. Studies to understand the problem found that many of the issues stemmed from the reliance on numeric paging technology. The University Health Network (UHN) began to address these issues by implementing a number of technology solutions. Although successful, these solutions created new issues that need to be understood and addressed. The purpose of this study was to evaluate the interprofessional communication tool (IP Tool) used to send electronic messages, uncover the new and unintended consequences of implementing this technology, and to better understand the gap between what physicians and nurses perceive as an urgent issue. This was a mixed-methods study utilizing semi-structured interviews to obtain feedback on the impact of the IP Tool, followed by the distribution of a survey to specifically explore the gap in what physicians and nurses perceive as an urgent issue. The semi-structure interviews uncovered 5 main themes; accountability; increase in communication; perception of urgency; knowledge of inappropriate use; and gaps in the tool or workflow. The electronic format of the messages sent using the IP Tool facilitated the use of the system to create accountability and at times absolve oneself of responsibility. Removing some of the barriers to communicating seen previously with paging increased the amount of communication and interruptions, which led to features of the IP Tool being leveraged and other tactics being used to elicit responses and improve personal productivity. Other workflow issues and gaps in the tool such as policy preventing the use of the electronic communication to clarify medication orders were identified. The perceptions of urgency survey found that there is not a significant gap between physicians and nurses in terms of how each discipline defines the clinical urgency of an issue. The gap exists when the element of time is used to determine urgency. There was also variation within disciplines and across disciplines in regards to how an urgent and non-urgent issue is defined. Clinical communication is complex. Technology has the potential to resolve many of the issues but some of the issues relate to the interprofessional nature of healthcare and not easily resolvable with technology. In fact, technology can accentuate these interprofessional issues and create new problems that need to be addressed. In exploring one of these interprofessional issues, specifically the gap between what physicians and nurses perceive to be an urgent issue, it was found that both disciplines generally agree on what constitutes a clinically urgent issue. The element of time is the primary sources of disagreement. More work to improve clinical communication is necessary and must be conducted within the context of continuous quality improvement as the healthcare environment is constantly changing. / Graduate

There are numerous empirically described problems of communication in healthcare. The doctor/patient relationship is fundamental to many such problems. The changing nature of healthcare and the doctor/patient relationship is explored in this thesis. An increasing evidence base demonstrates that patient outcomes in healthcarea re directly relatedt o clinical communication. However, more fundamental than patient outcomes is the very nature of personhood and the effects illness has on individual autonomy. A theory of human need provides the foundation for discussion. Autonomy in healthcare is discussed in these terms and is argued as a basic human need. Moreover, human communication is argued as a basic human need using the same theoretic approach. It therefore follows logically that health professionals have the same duties and responsibilities to meet basic human communication needs on the same terms as those for autonomy. The relationship between autonomy and communication is shown to be a reflexive one. A theory of democratic communication is drawn on to describe the type of communication that will meet autonomy and communication needs. This is set in the context of healthcare. Consent in healthcare is used to show how far we have come in meeting communication and autonomy needs. Given the arguments o far it is reasonable to expect medical education to respond to the changing and recognised needs of the users of healthcare. The role of effective communication in medical education programmes is explored. Finally, a strategic approach to organising and delivering a communication curriculum is proffered which tries to meet both the philosophically and democratically argued basic needs. The resulting communication curriculum combines theoretic foundations with a pragmatic approach to the problems of clinical practice. If the approaches in this thesis are followed then communication can no longer be perceived as something doctors do after they have completed other medical tasks. Effective doctors have to be effective communicators in order to meet patients' needs.